Plan for Return to Clinical Practice in Respect of Covid-19 – Pebble Hill Massage Therapy

This plan was developed with the goal of reducing the risk of exposure to the virus that causes Covid-19 for both patients and the practitioner within our clinical setting.  All therapists and patients must commit to these procedures to resume Registered Massage Therapy Services.  This plan is based on current recommendations from health and safety regulatory bodies. The content is subject to change due to the unknown characteristics of the Covid-19 and the global pandemic.

“Coronavirus is transmitted via liquid droplets when a person coughs or sneezes. The virus can enter through these droplets through the eyes, nose or throat if you are in close contact.

The virus is not known to be airborne (e.g. transmitted through the particles floating in the air) and it is not something that comes in through the skin.

It can be spread by touch if a person has used their hands to cover their mouth or nose when they cough. That’s why we recommend you cough or sneeze into your arm and wash your hands regularly.”

Source: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/how-it-spreads

The overall aim of these protocols is to reduce potential coronavirus transmission by:

  • Required ongoing self-assessment for signs of Covid-19 related illness in both the patient and the therapist
  • Reducing all physical, non-treatment related interactions amongst all people within the practice environment
  • Hand hygiene requirements
  • Avoiding face touching
  • Enhanced cleaning protocols
  • Appropriate and correct use of personal protective equipment (PPE)
  • Meeting professional obligations, particularly related to informed consent and liability insurance

Self-Assessment & Screening:

Prior to Arrival

  • Patients will be informed about their responsibilities at the time of booking. A notice will be placed on the website, and the online booking software will send them a copy of these protocols.
  • One day prior to their booked appointment, the patient will be emailed a mandatory health survey and are asked to stay home if they experience any symptoms of Covid-19.
  • The therapist will use the BC COVID-19 Self-Assessment tool daily and commits to cancelling all appointments if symptoms appear. The tool can be found here: https://bc.thrive.health/covid19/en
  • Symptoms of Covid-19 are similar to other respiratory illnesses and seasonal allergies.  An appointment must be cancelled immediately if either the patient or the therapist presents with even mild symptoms that may be signs of Covid-19 including:
    • fever, cough, chills, shortness of breath, sore throat or pain with swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue, loss of appetite
  • Covid-19 Symptoms may range from mild to severe. Patients are required to cancel appointments if they experience what they determine to be ‘just the sniffles,’ ‘seasonal allergies’ or ‘just feeling under the weather,’ on the day of their appointment.
  • Patients must confirm that they have not been in contact with anyone displaying illness, or signs and symptoms of Covid-19 within 14 days prior to their treatment.
  • The patient will be required to sign a consent and liability waiver with respect to Covid-19 prior to every treatment.
  • As a part of the consent form, patients must commit to understanding that while we have taken all possible measures to minimize risk of viral transmission, the nature of massage therapy means that physical distancing is not possible in the treatment room.
  •  Patients with higher risk profiles and/or weakened immune systems should consider alternatives for care and postpone treatment. 
  • The therapist and patient must agree that the therapeutic benefit of massage therapy outweighs any potential consequence of treatment, including the possibility of viral transmission.
  • Patients who develop even mild illness or symptoms must cancel booked appointments, even without notice.  They will NOT be charged a late cancellation fee if they cancel due to illness.

Upon Arrival

  • Patients will wait in their car until 5 minutes before their appointment time as the door will be locked until this time. If the blinds are open on the door, it is unlocked and you may enter.
  • Patients will enter and walk immediately to the marked sanitation station and use the hand sanitizer as per posted instruction. Disposable masks will be found here and you will be asked to put one on if you are not already wearing a mask.
  • Masks are mandatory throughout the clinic including the common areas, treatment room, and restrooms, as well as to exit the clinic. Patients may use their own clean reusable mask, or a disposable one will be available for $1.00.
  • The patient will be required to wear the mask the entire time during treatment except for when in prone (face down) when they can slide the mask under their nose or chin (whatever is preferred).  The patient must slide it back over both mouth and nose prior to going supine (turning over).
  • The therapist will advise the patient of their own current results from the online BC COVID-19 Symptom Self-Assessment tool.
  • Patients must confirm that they have done a pre-screening and have no signs of Covid-19 as outlined here: http://www.bccdc.ca/health-info/diseases-conditions/covid-19/about-covid-19/symptoms
    • Patients will be asked to confirm their own current results from online BC COVID-19 Symptom Self-Assessment tool.
  • Patient must confirm that they have not travelled outside British Columbia within 14 days prior to their appointment.
  • The treatment will be cancelled immediately if the patient does not meet the pre-screening criteria upon physical presentation at the clinic.

Physical Distancing

Reception & Shared Clinic Space:

  • Only 1 patient is permitted in the clinic entrance at any given time. Patients must arrive unaccompanied unless patient is a minor who requires parent or guardian or infirm, and needs assistance. 
  • Parent, guardian or any assistant needed, must follow and comply with all patient and clinic pre-screening and protocol including wearing a mask.
  • The therapist and the patient will both maintain a space of 2 meters (6 feet) distance between each other in all clinic areas that are outside the treatment room.
  • The fabric sofa in the waiting room has been covered with plastic and is not intended for seating at this time. There is only one plastic/metal chair left should a patient need to be seated.
    • Single use bottles of water will be available and patients are sked to take the bottle with them when they leave.
    • Patients are asked to leave promptly after their appointments.
  • Nothing remains in the clinic space that cannot be disinfected after each touch.
  • Appointment times are scheduled to allow for enhanced cleaning between appointments.
  • Patients are asked to arrive on time and not early or late for appointments.
  • The clinic door will be locked during and between treatments to prevent anyone from entering the space. All door handles will be disinfected between appointments.

Within the Treatment Room:

  • It is not possible to maintain physical distancing while in the treatment room.
  • Patients will be asked to keep all personal belongings in the plastic bin provided for their use, which will be found on the table beside the chair in the treatment room.  The chair  and bin will be sanitized between patients.
  • Patients will be asked to limit the items they bring into the clinic, and remove from the clinic everything that they bring with them.

Restroom for Patient Use:

  • The restroom has been equipped with single use hand towels and proper hand washing instruction posters. All used hand towels will be removed from the restroom between each treatment and the bin will be sanitized.
  • A foot activated waste bin is in the restroom next to the sink, lined with a garbage bag for all paper towel/ Kleenex disposal.
  • All high touch surfaces in the restroom will be sanitized between each treatment.

Hand Hygiene & Face-touching

Reception & Shared Clinic Space:

  • Immediately upon entering the clinic space the patient must go to the marked sanitation station directly in front of them in the waiting room and use the hand sanitizer as per posted instructions and put on the mask provided if they are not currently wearing a mask.
  • The therapist will wash hands thoroughly for at least 20 seconds between patients, before and after disinfecting spaces, before donning gloves and after taking gloves off, and before donning or doffing other PPE like face masks or shields.
  • Hand washing protocols will be posted visibly at the sink.
  • A tap payment system is available for card use and will be sanitized after each use.  Receipts will be emailed, not printed.

In the Treatment Room:

  • The therapist will open the door to the treatment room and allow the patient to enter. The therapist will open/close the door before, during and after the treatment as required.
    • Hand sanitizer is available within the treatment room; patients will be asked to wash or sanitize their hands after the treatment.

Avoid Face Touching:

  • The therapist will communicate with the patient that coronavirus can be transmitted by touch if droplets are on the hand when it touches the face, as it can transfer those infected droplets to the mouth, nose or eyes.
  • Tissue will be available throughout the clinic; in the reception area, treatment room and washroom in order that patients and therapists may use tissue to address an itch and/or touch the face for any other reason.
  • Patients are required to wear provided face masks that cover both the nose and mouth at all times within the shared clinic space.
  • Therapists are required to wear face masks during all contact with patients, even when socially distanced.  

Enhanced Cleaning Protocols

  • Additional time has been scheduled between patients to allow for thorough cleaning of the treatment room.
  • Visibly soiled surfaces will be cleaned and disinfected with a Canada Health Approved for use against Covid-19 disinfectant as listed here: https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html
  • Common areas will be cleaned and disinfected at least three times a day, including the restroom.
  • All high touch surfaces will be cleaned and disinfected between patients, regardless of appearances.  High touch surfaces include (but are not limited to):
    • Light switches, stool cover, chairs, doorknobs, POS machine, electronic devices, table surfaces, chairs, stools, faucets, etc.
  • The treatment table, face cradle, pillows, bolsters, lotion and oil bottles will be disinfected immediately after each treatment.
  • Heating pads will be used with a heat-safe, washable vinyl cover.
  • All linens, including blankets and pillowcases are single use and will be laundered using high heat and detergent between each appointment.

Personal Protective Equipment

  • The therapist’s disposable facemask will be changed between appointments.
  • The therapist will wear a scrub top or apron that will be changed between appointments.
  • The therapist will wear non-latex gloves if/when appropriate.
    • Gloves may be appropriate when over-use of cleaning and/or chemicals causes skin irritation, or when the therapist’s hands or skin of the hands are otherwise injured.
  • Hands will be washed prior to putting the gloves on and immediately after removing them.
  • Gloves are also considered appropriate and will be worn by the therapist at the patient’s request.
  • Patients are required to face mask in the clinic immediately after sanitizing their hands, in all shared clinic spaces, the treatment room, restroom and when exiting the clinic.

Professional Obligations

Liability Insurance:

  • The therapist carries professional liability insurance.
  • The therapist is following all the health and safety guidelines outlined by the College of Massage Therapists of British Columbia (CMTBC), the Provincial Health Officer, WorkSafe BC and the Registered Massage Therapists Association of BC and they are taking all reasonable precautions to clean and disinfect the clinic and all the surfaces within the treatment room.
  • No guarantees have been made by the therapist that the patient may not come in contact with COVID-19 at or during an appointment.

Informed Consent:

In the current environment of Covid-19 risk, informed consent requires that the patient be informed and understands that:

  • Any massage therapy treatment involves some risk of Covid-19 transmission;
  • The therapist is following protocol to help reduce or mitigate risk where possible, but that risk cannot be reduced to zero;
  • The patient consents to the treatment despite some risk;

And the RMT will document the patient’s consent in advance and at every treatment.

In the Event a Patient Tests Positive for Covid-19 having been to a Massage Therapy Appointment within the 14-days Prior to Onset of Symptoms:

  • The patient will contact the therapist and inform her of positive test results and possible transmission of the virus immediately.
  • The therapist will immediately self-isolate.
  • The therapist will call public health at 8-1-1 to report the possible transmission and act on direction of Provincial Health.

In the Event a Patient Alleges They Caught COVID-19 from the Therapist:

  • The therapist will immediately call public health at 8-1-1 to report the alleged transmission, providing both the name of the RMT and the name and contact details of the patient.
    • The patient must agree to the release of this information under these circumstances in order to receive treatment.
  • All massage therapy appointments will be cancelled and the Therapist will cease to provide services until Public Health has investigated and provided direction.
  • The therapist will immediately self-isolate until Public Health has investigated and provided direction.

In the Event the Therapist Catches COVID-19 or Displays Symptoms of Covid-19:

  • The therapist will immediately self-isolate.
  • The therapist will call public health at 8-1-1 to report the symptoms and request access to Covid-19 testing.
    • If testing is granted:
      • All massage therapy appointments will be cancelled and the Therapist will cease to provide services until test results are returned negative.
      • If testing proves positive the therapist will follow Public Health directives in informing patients treated over the previous 14 days about potential transmission.
    • If testing is not granted:
      • All massage therapy appointments will be cancelled and the Therapist will cease to provide services for a minimum of 10-days beyond the onset of symptoms, and/or until symptoms cease.

In the Event the Therapist Comes into Close Contact with Someone Showing Signs of Illness or Tests Positive for Covid-19:

  • The therapist will immediately self-isolate.
  • All massage therapy appointments will be cancelled and the therapist will cease to provide services until:
    • The close contact has been tested for Covid-19 and the results proved negative and the therapist is well,
    • OR after self-isolating for 14 days and having no symptoms of fever develop.
    • OR being cleared by a public health official.

Asymptomatic Spreaders

  • Asymptomatic transmission of the coronavirus is an unavoidable risk of practice until we’ve acquired herd immunity; there is an effective treatment or vaccine against Covid-19.
  • We have put into place protocols to help mitigate that risk as outlined in the preceding documentation.
  • No guarantees have been made by the therapist that the patient may not come in contact with COVID-19 at or during an appointment.

Thank you for your cooperation and understanding.